We’re beginning to understand that mutational profiles can tell us something about the character of the leukemia, said Elizabeth Griffiths, MD, associate professor of oncology, department of medicine, Roswell Park Comprehensive Cancer Center.

We’re beginning to understand that mutational profiles can tell us something about the character of the leukemia, said Elizabeth Griffiths, MD, associate professor of oncology, department of medicine, Roswell Park Comprehensive Cancer Center.

I think we’re beginning to understand that mutational profiles can tell us something about the character of the leukemia. Historically, we define patients as either fit for induction or unfit, and we made therapy decision largely based on those clinical factors. Using mutational profiles, we can actually identify patients whose disease is likely to be intransigent to conventional chemotherapies, and with that approach, we can actually slate patients to receive therapies that are more likely to benefit them.

So, instead of giving them traditional cytotoxic therapies, which tend to have a very low rate of remission induction, in say patients with p53 mutant disease or complex kayrotype. We might offer them an alternative induction strategy, potentially with a novel therapeutic combination like one of the venetoclax combinations. I think that recognition is likely to change the way we approach patients in the future.

Right now, a fit patient would still likely be offered a conventional induction strategy or Vyxeos, the CPX-351 liposomal cytarabine-daunorubicin combination. But perhaps in the future, we might be able to change our approach.

I think the molecular profiling has also unveiled a variety of targets that we can use in combination with traditional chemotherapeutics. So, as highlighted at this meeting by Keith W. Pratz, MD, associate professor of oncology, John Hopkins University, and Eytan Stein, MD, hematologic oncologist, Memorial Sloan Kettering Cancer Center, upfront combinations of both novel Flt-3 inhibitors and IDH [isocitrate dehydrogenase] inhibitors with conventional chemotherapy like 7+3 can provide really substantial rates of remission induction success and potentially deep molecular emissions, which may translate into better long-term survival for patients.